Another thing to check off.

I can check another thing off on my list for breast cancer care. Yep. I am done with chemo! I finished yesterday. My sister and my niece were there with me when Wayne pulled out my IV and announced to the room of patients getting chemo that "Mary is done with her chemotherapy!" It was wonderful to hear these words announced. I walked out of there with a spring in my step and a congratulatory coffee mug.



So...what is next? I haven't really thought too much about the next phase of my care. I was really trying to take it one step at a time. Right now, I have a month off from 'cancer care' with no appointments scheduled at all. Hopefully, I will recover easily from this last chemo and will see my hair start to come back in. I am returning to work on June 1 and for those of you who know how stubborn I am, you know I will be returning to work on June 1! I may still be bald, but hey...it's been said I have a nice head!



When I go back to the oncologist in June, I will be started on Tamoxifen. This medication comes in a daily pill that has been used for more than 20 years to treat patients with advanced breast cancer. It is now commonly used as an additional therapy following primary treatment for early stage breast cancer. It works by suppressing the production of estrogen-a hormone made by your ovaries which promotes the growth of cancer cells. Sometimes tamoxifen is called an "anti-estrogen" and helps prevent the original breast cancer from returning. Like any drug, there are positives and negatives to being on tamoxifen. Some women experience a lowering of their blood cholesterol levels and slower bone loss (osteoporosis). But...tamoxifen does have side effects (NCI, n.d.). In general, they are similar to the symptoms of menopause including hot flashes, headaches, fatigue, nausea/vomiting, vaginal dryness and/or itching, and skin rashes. Weight gain is another side effect (ACS, 2006). Tamoxifen also increases the risk of uterine and endometrial cancer In one study, women who took tamoxifen had more than twice the chance of endometrial cancer. Data from one large treatment study also found there is a small increase in the number of blood clots in women taking tamoxifen; and are at increased risk for developing cataracts, corneal scarring and retinal changes in the eyes. Tamoxifen has also been known to cause liver cancer in lab rats but this has not been documented in humans. It can cause liver toxicities in humans though and in one study was associated with gastrointestinal cancer (NCI, n.d.)



By my read, this is not a great drug to be on. The question becomes: Do the benefits of tamoxifen in treating breast cancer outweigh its risks? According to the National Cancer Institute (n.d.) the benefits of tamoxifen as a treatment for breast cancer are firmly established and far outweigh the potential risks. But I keep going back to this question: if I have to take a drug for the next 5 years that has so many side effects, why not just remove the problem-the ovaries. They are the organs that produce that estrogen that the tamoxifen is suppressing. From there I think, why not remove the uterus too...and any other useless organ that can just become a haven for cancer cells?



Of course I had to ask Zander, the oncologist this question. He said it was an option but the surgical risks may be greater than the benefits it I was able to tolerate the tamoxifen. Not getting the answer I wanted, "oh...great idea! Let's schedule you for surgery" I had to ask Chara, the oncology NP. While she gave me more information about tamoxifen and long-term use (more than 10 years), she essentially agreed with Zander. So we decided on a 1-year trial of tamoxifen. If I'm having problems with it, off to surgery I go. If not, stay the course.



So what else is store for me? Visits to the oncologists every 3 months. These will include blood draws for a blood tumor marker called CA27-29. This marker is found in the blood of most women with breast cancer. Typically it will remain at a stable level, somewhere less than 34. I will have it drawn and observed over time. An increase in the level of this marker can be a cue that my breast cancer has recurred or I have developed a cancer of the colon, stomach, kidney, lung, ovary, pancreas, uterus or liver (medicinenet.com, 2006). These cancers will also cause an increase in CA27-29. During my visits I will also have a chest x-ray or a chest CT scan to look for recurrence in the bones of the chest. That is one of the more common sites of breast cancer recurrence.



So much to look forward to! I will do it all. I want to be able to look back knowing that I took every step I could to treat my cancer and increase my chances for a long and health life. I've still got quite a few things to do. And tomorrow, we are going to look at a boat.


References


American Cancer Society [ACS] (2006). Hormone therapy. Retrieved May 15, 2007 from
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Hormone_Therapy_5.asp?sitearea=

Medicinenet.com (n.d.) Definition of CA27-29. Retrieved May 15, 2007 from http://www.medterms.com/script/main/art.asp?articlekey=39199

National Cancer Institute [NCI] (n.d.) Fact sheet: Tamoxifen: Questions and answers. Retrieved May 15, 2007 from http://www.cancer.gov/cancertopics/factsheet/Therapy/tamoxifen